TITLE 40.SOCIAL SERVICES AND ASSISTANCE

Part 3. TEXAS COMMISSION ON ALCOHOL AND DRUG ABUSE

Chapter 147. CONTRACT PROGRAM REQUIREMENTS

The Texas Commission on Alcohol and Drug Abuse (Commission) adopts new Chapter 147, §§147.101 - 147.116, 147.201 - 147.204, 147.301 - 147.304, 147.401, 147.402, 147.501, 147.502, 147.601 - 147.604, and 147.701, concerning Contract Program Requirements, with changes to the text that was published in the August 29, 2003, issue of the Texas Register (28 TexReg 7226).

The new Chapter 147 has been reorganized to provide a more functional and logical framework. It incorporates portions of other existing rules concerning the delivery of program services funded by the Commission. Narcotics treatment programs, HIV, women's services, prevention/intervention and outreach, screening, assessment, and referral (OSAR) services are affected by these changes.

Most of the funding specific rules for Commission funded prevention programs, formerly found in 40 TAC Chapter 144, Contract Requirements, and 40 TAC Chapter 148, Facility Licensure, have been moved to the new 40 TAC Chapter 147. These rules set out specific program requirements for program selection, target population, reporting, evaluation, and each of the six Center for Substance Abuse Prevention (CSAP) strategies.

The new rules also take into account the new capacity and outcome measures requirement of the Performance Partnership Grant (PPG), which CSAP and the Substance Abuse and Mental Health Services Administration (SAMSHA) is proposing for fiscal year 2005. As a result, requirements pertaining to capacity management and outcome measures are included in this new rule.

The public comment period began on August 29, 2003, with the publication of the proposed rules in the Texas Register and on the Commission's web site, and ended October 15, 2003. Public meetings to discuss the rules were held during the comment period in Austin, Dallas and Houston. The Commission received the majority of comments in writing by e-mail, fax and U.S. mail. Commission staff summarized the comments received and published draft responses for review on the Commission's web site in advance of its November 12, 2003, open meeting. The draft included a number of changes in response to the concerns expressed. As directed by the Commissioners at the November 12 meeting, the rules were revised further and published along with a draft final order on the Commission's web site in advance of the December 9, 2003, open meeting. Chapter 147 was approved for adoption during that meeting.

The Commission received comments on the proposed rules from Amarillo Council on Alcoholism and Drug Abuse (Amarillo Council); The Association of Substance Abuse Programs (ASAP); Austin Travis County MHMR; Avenues Counseling Center; Brazos Valley Council on Alcohol and Substance Abuse; Heart of Texas Council on Alcohol and Drug Abuse; Land Manor; Phoenix House; Rainbow Days, Inc.; Riverside General Hospital; Serenity Foundation of Texas; Southeast Texas Regional Planning Commission; Tarrant County Hospital District; University of Texas Southwestern Medical Center at Dallas; Volunteers of America; West Texas Counseling and Rehabilitation Programs; and various individual commenters. The specific comments received and the Commission's responses appear below:

General Comments and Observations:

The Association of Substance Abuse Programs (ASAP) comments that the Commission should defer any action on the proposed rules. The Commission agrees that it should not enact the changes contained in 40 TAC Chapter 147 in a manner that has a substantial impact on service delivery in fiscal year 2004. The Commission plans to adopt proposed 40 TAC Chapter 147 with an effective date of September 1, 2004. Proceeding in this manner will enable the Commission to provide guidance to parties who anticipate contracting with the Commission in the future.

Rule-Specific Comments in Numerical Order:

Subchapter A. Prevention and Intervention.

An individual commenter is concerned about individual record keeping for intervention counseling. The Commission responds that the new rule clarifies requirements for documentation under the existing rule. The new rule does not add significant record keeping requirements to the existing rule.

Austin Travis County MHMR requests that the rules clearly state whether they apply to HIV and HEI. The Commission responds that Commission funded HIV/HEI programs are guided by §§147.201 - 147.204 which specifically address HIV services. HIV/HEI are not traditional prevention or intervention programs and therefore are guided by separate rules.

Austin Travis County MHMR also requests information dissemination be defined in 40 TAC Chapter 141. The Commission responds that information dissemination is defined in §141.101(20)(c).

§147.103(e). Program Design and Implementation.

Tarrant County Hospital District and UT Southwestern Medical Center at Dallas request that the curricula referenced in the rule be approved by the Commission. The Commission responds that no change is needed as the rule adequately specifies the requirements for such curricula.

§147.103(g). Program Design and Implementation.

Brazos Valley Council on Alcohol and Substance Abuse requests that the Commission delete the requirement that a program obtain signed agreements from other mental health, health care, and social service agencies. The Commission notes that the commenter referred to the current, not proposed rule. The Commission responds that the proposed rules deletes this requirement and instead requires the program to maintain a resource directory that contains current information about local referral resources, including location and contact information, services offered, and eligibility criteria.

§147.107(e). Information Dissemination.

Amarillo Council, Austin Travis County MHMR and Avenues Counseling Center are concerned about collecting individual participant demographics for this activity. The Commission responds that the intent of this rule is not to collect individual participant demographics and has revised the rule.

§147.108(c). Prevention Education and Skills Training.

UT Southwestern Medical Center at Dallas requests that the curricula referenced in the rule be approved by TCADA. The Commission responds that no change is needed as the rule adequately specifies the requirements for such curricula.

§147.109(c). Alternative Activities.

Amarillo Council is concerned about collecting individual participant demographics for this activity. The Commission responds that the intent of this rule is not to collect individual participant demographics and has revised the rule.

§147.110(a). Problem Identification and Referral.

Tarrant County Hospital District suggests a revision to the rule to require follow-up on only those participants receiving case management services. The Commission declines to make this change as follow-up is appropriate for referrals of program participants.

§147.111(d). Community-Based Process.

Rainbow Days, Inc. comments that §147.110(d) contains requirements that are no longer used as performance measures for the FY 04 contract. The commenter believes that the rule should be amended to incorporate this change. The Commission responds that the information is useful and therefore should be collected even though it does not constitute a performance measure. To the extent that these requirements change in FY 05, the amended requirements can be included in the FY 05 contract.

§147.112. Environmental and Social Policy.

Amarillo Council and an interested individual are concerned about collecting individual participant demographics. The Commission has revised §147.112(g).

§147.113(b). Intervention Services.

Tarrant County Hospital District suggests that this rule be revised to reflect that not every participant attends school. The Commission responds that current school attendance is not required to collect the requested information.

§147.113(b)(1). Intervention Services.

A concerned individual comments that there is not enough time to complete a screening on all participants. The Commission responds that intervention services only target indicated populations. The intent of the rule is that each participant receiving indicated prevention services will receive the screening set forth in the rule to ensure that the individual receives appropriate services.

§147.113(b)(2). Intervention Services.

Tarrant County Hospital District requests a change to §147.112(b) regarding intervention services "screening" and requests that the Commission use the term "assessment." The Commission declines to make this change as it believes the term "screening" prevents confusion with a traditional substance abuse "assessment."

§147.113(b)(2). Intervention Services.

ASAP requests clarification of the rule provision to limit the collection of information about the family of intervention program participants to that which is allowed by law. The Commission responds that there are various laws regarding privacy of information which may protect against requirements to disclose requested information. It is the responsibility of the provider to ascertain whether a particular inquiry is appropriate under the circumstances.

§147.114(c). Community Coalitions.

A commenter questioned whether community coalitions could provide youth prevention and intervention and youth primary prevention under §147.114(c). The Commission responds that this is not permitted because community coalitions are not intended to provide direct services.

§147.116. Pregnant and Parenting Adult and Adolescent Female Prevention Services.

UT Southwestern Medical Center at Dallas suggests adding a standard to require a provider to provide direct supportive services under §147.116. The Commission responds that such services can be provided directly or through referral.

§147.116(2). Pregnant and Parenting Adult and Adolescent Female Prevention Services.

Tarrant County Hospital District requests that the curricula referenced in the rule be approved by TCADA. The Commission responds that no change is needed as the rule adequately specifies the requirements for such curricula.

§147.116(1), (2), (3), and (7). Pregnant and Parenting Adult and Adolescent Female Prevention Services.

UT Southwestern Medical Center at Dallas submits additional language to expand requirements for PPI programs under these rules. The Commission responds that the commenter may address the suggested changes in their organizational policies and procedures.

Subchapter B. Standards of Care for HIV Programming.

Austin Travis County MHMR comments that Subchapter A, Prevention and Intervention, is not specific enough regarding HEI and HIV outreach. The Commission responds that commission funded HIV/HEI programs are guided by Subchapter B, §§147.201 - 147.204 which specifically addresses HIV services. HIV/HEI are not traditional prevention or intervention programs and therefore are guided by separate rules.

§147.204(b). Minimum Operational Requirements for HIV Early Intervention (HEI) Programs.

A commenter wants a definition of service coordination under §147.204(b). The Commission responds that the term service coordination does not need additional definition beyond that contained in §141.101(113).

§147.304(c). Minimum Operational Requirements (relating to Pharmacotherapy).

West Texas Counseling and Rehabilitation Programs is concerned that the 18 month rule will have detrimental effects on the methadone community. The Commission responds that the 18 month rule does not suggest that a client should be removed from methadone maintenance. The 18 month rules moves the responsibility for a client's methadone maintenance from the public funding system to the client or other private payer sources. The rule provides that a client who can demonstrate medical necessity may be granted a waiver by the Commission's Executive Director to continue treatment on public funding.

§147.303. Required Services. (relating to Pharmacotherapy)

A commenter suggested that treatment providers sometimes prevent compliance with §147.303. TCADA acknowledges this concern and directs the commenter to §§148.204, 148.207 and 148.208, which ensure access to appropriate services on a nondiscriminatory basis.

§147.304(b). Minimum Operational Requirements. (relating to Pharmacotherapy).

A commenter suggested that §147.304(b) is awkwardly worded. The Commission agrees and has revised the rule.

§147.304(b). Minimum Operational Requirements. (relating to Pharmacotherapy).

An individual commenter requests less prescriptive language in this rule. The Commission responds that the prescribed number of sessions is consistent with the Commission's goals for Opiod Treatment Programs (OTPs) which is to address the multiple issues of narcotic addiction.

General Comments and Concerns Regarding Subchapter D. Outreach, Screening, Assessment and Referral (OSAR) Services.

Austin Travis County MHMR suggests deletion of the assessment requirement. The Commission responds that it believes the assessment component is critical to functionality of the front door process. The Commission further responds that the proposed rule will not have any impact on current OSRs. The proposed rule will affect the organizations awarded OSAR contracts in FY 05 and are intended to provide general guidance regarding the expectations of the OSAR services the Commission expects to purchase for FY 05. The specific detailed expectations for OSARs will be set forth in the upcoming Request for Proposals (RFP) and FY 05 contracts. The Commission will take into consideration any additional costs associated with providing OSAR services as it prepares the RFP for FY 05 as well as the other specific concerns expressed by commenters.

Austin Travis County MHMR suggests adding §§147.403 - 147.407 to define performance measures and performance measure review for OSARs. The Commission responds that the commenter's suggestions are more appropriate for contract requirements.

Austin Travis County MHMR appears to disagree with the OSAR concept and repeatedly refers to a Network Maintenance Organization (NMO). The Commission responds that OSARs are integral to the statewide service delivery continuum and the NMO is not an organizational structure mentioned in §147.401 and §147.402.

Phoenix House commented that treatment providers will have difficulty working with OSARs who do not work for their facility. Therefore, a requirement should be placed on receiving programs to coordinate with the referring OSAR. The commenter provided specific examples of ways the receiving agency could cooperate. TCADA acknowledges this concern and directs the commenter to §§148.204, 148.207, and 148.208 of the Standard of Care.

Phoenix House asks if there will be a place for an OSAR in the NorthSTAR region and if so, how will it be distinguished from the ACT team function. Further, how will the OSAR mesh with NorthSTAR and the components of NorthSTAR? The Commission responds that there will not be a place in the NorthSTAR region for OSARs.

Southeast Texas Regional Planning Commission (SETRPC) and Phoenix House comment on the costs associated with implementing the new rules for OSARs and request interpretations of how the rules should be implemented.

Specific Comments and Concerns Regarding the Implementation of Subchapter D. Outreach, Screening, Assessment and Referral (OSAR) Services.

SETRPC, Phoenix House, Amarillo Council, ASAP, Serenity Foundation of Texas, and interested individuals have each submitted very specific concerns regarding the implementation of OSAR rules.

The specific concerns of SETRPC are that the duties the new rules impose on OSAR providers are not feasible under the current funding levels and resulting staffing structure that would be needed to perform them. SETRPC believes that the level of service required would reduce the number of clients served and reduce the ability of the counselor to properly bond with the client. Additionally, SETRPC believes that the requirement for continuous availability for screening and assessments is not realistic under current budgets. SETRPC believes that the services required by §147.402(l)(1) and (2) are not being done by most OSRs in Texas, thereby creating a larger workload for the providers who do perform these services. SETRPC requests that the terms "long-term service coordination" and "high-severity clients" be defined, as those terms are used in §147.402(l)(3). SETRPC questions whether the post-discharge follow-up was in addition to the 60 day treatment follow-up contained in 40 TAC Chapter 147. SETRPC also questions how long the requirement for long term monitoring continues as a service delivery requirement for OSARS and whether an OSAR will be responsible for ongoing individual therapy.

Phoenix House also comments on the cost of implementing the proposed OSAR model, noting it will be more expensive and difficult to manage. Phoenix House provides the following detailed list of questions regarding the expectations TCADA has for the OSAR:

a. How many OSAR employees per 100,000 population is considered sufficient to serve the community?

b. How many clients will an OSAR be expected to carry at any one time on a case load?

c. When should an OSAR drop a client so that new clients can be added to the case load?

d. How long is considered reasonable to carry a client on a case load?

e. Does the OSAR responsibility extend to the entire family of the client? Do these individuals count also as far as number on case load is concerned?

f. Will sufficient funding be available to staff 24-7 as required in the new rules?

g. If client is too intoxicated to travel to the OSAR, will the OSAR be required to travel to the intoxicated client?

f. How many miles will the OSAR be required to travel in the middle of the night to serve an intoxicated client? How can the OSAR be assured the client will be there when the OSAR arrives?

g. What is the safety plan for an OSAR who serves a client in the middle of the night?

h. Considering that sometimes OSARs must send a client hundreds of miles away to receive treatment, how can the OSAR monitor and follow the client coordinating client's care across the continuum of care from a great distance?

i. What is the DSM-IV criteria for high severity clients?

j. To what extent will an OSAR be required to find a homeless client affordable housing to help client maintain sobriety?

k. Will there be special case managers who will deal with the clients who are high severity dually diagnosed and non-complaint? How will this be handled?

Amarillo Council comments that the requirement in §147.402(h) that the OSAR provide brief intervention is too broad in that it implies that the OSAR is required to provide outpatient treatment rather than the brief intervention model. The Council recommends that brief intervention be should be provided as pre-treatment or interim services by the OSAR.

Amarillo Council comments that care coordination or classic case management is a needed and valuable service and that OSAR providers are a logical choice to perform this function.

Amarillo Council believes that §147.402(1) and (m) sets forth a whole new service requiring the involvement of treatment providers, not just OSARs, and asks what type of care plan is envisioned? The Council inquires whether it is as an "authorization" plan.

The Council has concerns regarding terminology. The Council believes that criteria needs to be set in place defining "high-severity" clients because there could be a wide range of interpretations. The Council believes that the term "evaluating treatment" is too wide open and without setting up standard procedures, measures, authority, etc. and could lead to problems with subjective assessments. The Council questions how long term is "long term" and what does "monitoring" include?

Amarillo Council believes that the addicted and recovering population is a transient group especially in the early years of recovery and that there is no legal motivator or medication requirement or other necessary services to keep them in touch with the chemical dependency (CD) treatment providers or "case managers." Being able to maintain a "long term" CD related contact is a challenging proposition whether or not a client is maintaining sobriety. The Council believes that performance measures should reflect reality. The Council believes that the expectations in §147.402(m) are unclear and that there are many uncontrollable factors that would make "ensuring" a seamless episode of care almost impossible. Globally, the Council recommends that TCADA delete §147.402(l)(1) - (3) and (m) from the proposed rules in order to allow for more careful study and planning for the implementation of a CD related care coordination system in order to avoid a significant disruption to the system of care.

ASAP and Serenity Foundation of Texas further comment that the new services required by §147.402(l) will require additional funding and that the use of an OSAR may restrict the ability of rural providers to admit directly into their programs without using an OSAR. They also question what type of care plan is envisioned and asks if the rules require a modified "utilization review." They request clarification regarding the phase "evaluating treatment" as used in §147.402(l)(3)(A) and the terms "long term" and "monitoring." They comment that the requirements of §147.402(m) regarding a seamless episode of care are unclear and unrealistic. Lastly, they recommend deleting §§147.402(l) and (m) in their entirety and replace them with more generalized language.

An individual commenter noted that §147.402(l) will require a "super" case manager and that such staff will be expensive. The commenter further stated that the receiving agency should be required to coordinate admissions and discharge with the OSAR. The commenter questions whether the requirements of §147.402(l) include all funded services and whether funded agencies have to notify the OSAR when they utilize direct admission.

As noted above, the OSAR rules are intended to provide general guidance regarding the expectations of the OSAR services the Commission expects to purchase for FY 05. The specific detailed expectations of OSARs will be set forth in the upcoming Request for Proposals (RFP) and FY 05 contracts. However, the Commission recognizes that the comments can serve to facilitate discussion on the challenges of implementing the new OSAR model.

§147.402. Standards for OSAR Service Provision.

Heart of Texas Council on Alcohol and Drug Abuse asks whether an OSAR will be required to determine financial and clinical eligibility and how QCCs will screen and assess after hours. The commenter also inquires about the division of responsibility between the OSAR and treatment provider and about training requirements. The Commission responds that financial eligibility guidelines currently exist and, in the FY 05 contracts, both clinical and financial eligibility will be determined by the OSAR. Regarding screening and assessment, the organization's policies and procedures will reflect the physical location of the QCC and require that a QCC who performs screenings and assessments have access to a computer for data entry into BHIPS. Training requirements for OSAR staff are set forth in the rules of the respective licensing agencies and the provider's policies and procedures.

§147.402(d). Standards for Outreach, Screening, Assessment and Referral (OSAR) Service Provision.

Austin Travis County MHMR comments that requiring screening, assessment, and emergency response to be done using the Commission's Behavioral Health Integrated Provider System (BHIPS) is problematic because not all providers of those services use BHIPS. The Commission responds that it only requires its funded providers to use BHIPS and it anticipates that, in FY 05, all OSARs will be Commission-funded.

Austin Travis County MHMR suggests removing 24-hour accessibility to OSARs. Amarillo Council commented that it is not advisable to require screening and emergency response using BHIPS for 24 hours a day, seven days a week, since clients are often not in any condition to complete a BHIPS assessment. The Commission has provided guidance regarding what constitutes a screening. Screening information can be entered into BHIPS within 24 hours of the occurrence. Emergency response should be available at all times. Every crisis intervention may not constitute a screening.

§147.402(g). Standards for Outreach, Screening, Assessment and Referral (OSAR) Service Provision.

Amarillo Council further comments that the requirements of §147.402(g) are unclear and suggests that it would be more appropriate to say that the OSAR should "facilitate" admission to appropriate services. The Council also feels that §147.402(g) overlaps with the requirements of §147.402(l)(2). The Commission believes that the questioned language clearly sets forth expectations for OSAR conduct and OSAR coordination of client care and is therefore not duplicative. Therefore, the Commission declines to modify this requirement.

§147.402(h). Standards for OSAR Service Provision.

Austin Travis County MHMR states that definitions of brief intervention in Chapter 141 rules are not congruent with the requirement for action in §147.402(h). The Commission agrees and revises the definition of "brief intervention" in §141.101.

§147.402(i). Standards for Outreach, Screening, Assessment and Referral (OSAR) Service Provision.

Amarillo Council and ASAP question the use of the term "alternative" in §147.402(i). TCADA agrees with these comments and has revised the rule. ASAP also recommends moving this section to follow section §147.402(g). The Commission declines to make this change as it is unnecessary and does not serve to clarify the rule.

§147.402(j). Standards for Outreach, Screening, Assessment and Referral (OSAR) Service Provision.

The Commission has received a comment from Brazos Valley Council on Alcohol and Substance Abuse indicating that an intensive family psychosocial assessment, service plan, and discharge plan is required for the family. TCADA responds that such an assessment is not required by the rule. Screening and assessment shall, when appropriate, address the family as a unit and referrals shall be provided for family members, including prevention services for children.

Brazos Valley Council also requests that TCADA add a requirement for mandatory hours of services for the family and individual family counseling as needed. TCADA responds that family involvement is encouraged, but it does not believe that imposing this requirement is appropriate at this time.

§147.402(k). Standards for Outreach, Screening, Assessment and Referral (OSAR).

Brazos Valley Council on Alcohol and Substance Abuse requests that the Commission delete the requirement that a program obtain signed agreements from other mental health, health care, and social service agencies. The Commission notes that the commenter referred to the current, not proposed rule. The Commission responds that the proposed rules delete this requirement and instead require the program to maintain a resource directory that contains current information about local referral resources, including location and contact information, services offered, and eligibility criteria.

§147.502. Select Performance Measure Definitions.

Amarillo Council and ASAP are concerned that the minimum duration for length of stay of clients in treatment, as defined in the proposed rule, will limit clinicians' judgment on length of stay. Additional concerns are expressed regarding early discharge in appropriate circumstances. The Commission responds that 14 days is the suggested minimum duration for clients' length of stay in treatment. The Commission does not give a maximum paid length of stay if clinical necessity is documented. The Commission agrees that discharge prior to fourteen days may be appropriate and has revised §147.502(a)(3) accordingly.

§147.602. Purpose of Program.

A commenter questions why for profit entities are excluded from funding under §147.602. The Commission agrees with the commenter that funding is available for public and private entities and has revised the rule.

§147.602(a). Purpose of Program.

The commenter asks a question about §147.602(a) regarding the meaning of "individual plan." The section cited by the commenter does not exist in the proposed rule, nonetheless, "individual plan" in §147.604 refers to an "individualized treatment plan."

§147.603(a)(1). Availability of Services.

Brazos Valley Council on Alcohol and Substance Abuse requests that the Commission delete the requirement that a program obtain written agreements. The Commission responds that the proposed rule does not require written agreements.

§147.604(4), (5), (6), (9), (10), and (15). Individualized Plan of Services.

Riverside General Hospital suggests that the rule could be revised to include referrals to other community resources. The Commission agrees with the suggested change and has revised the rule.

§147.604(5), (6), (9), (10). Individualized Plan of Services.

ASAP and Volunteers of America comment that the proposed rule language puts provider counselors outside their scope of practice. In response to this comment, the Commission notes that the intent of the rule is not to require the provider to deliver the required services directly. The intent of the rule may be met by facilitating access or ensuring appropriate referral. The text of §147.604(4), (5), (9) and (10) has been revised to clarify these expectations. The text of §147.604(6) appears to be appropriate as written. In addition, minor grammatical revisions have been made to §147.604(5).

All comments, including any not specifically referenced herein, were fully considered by the Commission. In adopting 40 TAC Chapter 147, the Commission makes other grammatical and non-substantive changes for the purpose of clarifying its intent.

Subchapter A. PREVENTION AND INTERVENTION

40 TAC §§147.101 - 147.116

The new sections are adopted pursuant to the Texas Health and Safety Code §461.012(a)(15) which provides the Commission with the authority to adopt rules governing its functions, including rules that prescribe the policies and procedures it follows in administering any Commission program and §461.0141 which provides the Commission with authority to adopt rules regarding purchase of services. The new sections are also adopted under Texas Health and Safety Code §464.009, which provides TCADA with the authority to adopt rules and standards for the licensure of chemical dependency treatment facilities.

The codes affected by the adoption of the new sections are Chapters 461 and 464 of the Health and Safety Code.

§147.101.Applicability and Definitions.

(a) The rules in this subchapter apply only to funded programs providing prevention or intervention services.

(b) All funded programs must also comply with Chapter 148 of this title (relating to General Provisions).

(c) The words and terms used in this chapter shall have meanings set forth in Chapter 141 of this title, unless the context clearly indicates otherwise. The following definition is specific to prevention and intervention: Young Adults--Individuals aged 18 - 21 served by Commission-funded youth services prevention providers. Prevention providers may bill and report individuals aged 18 - 21 as youth if all other requirements are met.

§147.102.Youth Prevention Programs.

(a) The goal of youth prevention programs shall be to preclude the onset of the use of alcohol, tobacco and other drugs by youth and to foster the development of social and physical environments that facilitate healthy, drug-free lifestyles.

(b) Youth prevention programs shall offer universal and/or selective prevention strategies to youth and their families.

§147.103.Program Design and Implementation.

(a) The provider shall determine what population(s) the program is designed to serve: universal, selective or indicated.

(b) The program shall identify and describe the primary and secondary target populations including specific information about:

(1) age, gender, and ethnicity;

(2) risk and protective factors;

(3) patterns of substance use;

(4) social and cultural characteristics;

(5) knowledge, beliefs, values, and attitudes; and

(6) needs.

(1) address identified risks, needs and/or problems of the primary and secondary target populations;

(2) are designed to enhance protective factors;

(3) clearly describe behavioral and/or societal changes to be achieved; and

(4) are realistic in relation to available resources.

(d) The program shall establish objectives that are linked to the goals. Objectives must be measurable, have outcome and family strategies where appropriate.

(e) The program design shall be based on a logical, conceptually sound framework to connect the prevention or intervention effort with the intended result of preventing alcohol, tobacco, and other drug problems. Curricula selected shall be evidence based and appropriate for the target population served. The program shall maintain the fidelity of the program design.

(f) In order to carry out the program design, the program shall incorporate a combination of some or all of the Center for Substance and Prevention's (CSAP) prevention strategies. All youth prevention programs (YPP) and youth intervention programs (YPI) must at a minimum conduct prevention education and skills training as a core strategy.

(g) The program shall be designed to build on and support related prevention and intervention efforts in the community. The program shall establish formal linkages and coordinate with other community resources.

(h) The program shall be appropriately structured to implement the program design. The prevention effort shall be consistent with the availability of personnel, resources, and realistic opportunities for implementation.

(i) The program design, content, communications, and materials shall:

(1) be available in the primary language of the target population;

(2) be appropriate to the literacy level, gender, race, ethnicity, sexual orientation, age, and developmental level of the target population; and

(3) recognize the cultural context of the family unit.

§147.104.Key Performance and Activity Measures.

The program shall track and appropriately document the key performance and activity measures defined for the target populations and the services provided as outlined in the contract. The program must maintain adequate documentation to substantiate the reported numbers.

§147.105.Performance Measure Review.

(a) Programs will be held to specific key performance measures as stated in the contract.

(b) The Commission shall review actual performance on key measures and notify the program in writing if the program failed to achieve the expected level of performance.

(c) If the program fails to achieve the expected level of performance, the program shall respond within 30 days from the postmark date of the Commission's written notification with a timeframe in which the deficiencies will be resolved. The program must resolve the noted deficiencies or be subject to sanctions as described in the contract.

(d) The Commission shall take at least one of the following actions in response to performance deficiencies:

(1) notify the program in writing that timeframe for resolving deficiencies has been approved;

(2) specify additional conditions to include manual pay;

(3) impose contract restrictions or sanctions or terminate the contract.

§147.106.Staff Training.

(a) During the first six months of employment, all direct service prevention and intervention staff shall receive a total of 16 hours of training (or document 16 hours of equivalent training), with a minimum of three hours in each of the following areas:

(1) cultural competency;

(2) risk and protective factors/building resiliency;

(3) child development and/or adolescent development, as appropriate; and

(4) strategies for strengthening families.

(b) Staff shall have specific training in the curriculum implemented for prevention education/skills training before facilitating the curriculum independently.

(c) In subsequent years, all direct services prevention staff shall receive eight hours of prevention training related to the program design.

§147.107.Information Dissemination.

(a) Each program that provides activities within this strategy shall disseminate information about these topics as appropriate for the target population:

(1) the nature and extent of alcohol, tobacco, and other drug use, abuse, and addiction;

(2) human immunodeficiency syndrome (HIV) infection, tuberculosis (TB), Hepatitis, and sexually transmitted diseases (STDs); and/or

(3) information about available services and resources.

(b) The information shall be accurate and current.

(1) content; and

(2) mode, time, and location of delivery.

(d) The program shall document the number of individuals receiving written information/literature.

(e) For presentations, documentation shall include, as applicable:

(1) date, time, and duration of activity;

(2) location of activity;

(3) staff/volunteers conducting activity;

(4) purpose and goal of activity; and

(5) number of participants.

§147.108.Prevention Education and Skills Training.

(a) Education and skills training must be designed to affect critical life and social skills and include decision-making, refusal skills, critical analysis and systematic judgment abilities.

(b) The activities must include extensive interaction between the leader and the participants.

(c) Activities shall be conducted according to a written, time-specific curriculum, which is based on proven, effective principles.

(d) Each program that provides activities within this strategy must help participants gain knowledge and/or skills needed to access assistance or help with a problem.

(e) Documentation shall include, as applicable:

(1) date, time, and duration of activity;

(2) location of activity;

(3) staff/volunteers conducting activity;

(4) purpose and goal of activity;

(5) number of participants; and

(6) demographics of participants.

§147.109.Alternative Activities.

(a) Each program that provides activities within this strategy shall provide alternative activities designed to assist participants in:

(1) mastering new skills;

(2) developing/maintaining relationships;

(3) bonding with peers, family, school, and community;

(4) building cultural understanding, and honoring diversity; and

(5) identifying activities which offset the attraction to fill needs met by alcohol, tobacco and other drug use.

(b) Alternative activities shall be planned and conducted to complement the existing program design and proposed outcomes.

(1) date, time, and duration of activity;

(2) location of activity;

(3) staff/volunteers conducting activity;

(4) purpose and goal of activity; and

(5) number of participants.

§147.110.Problem Identification and Referral.

(a) General requirements. Each program will provide components to identify those who have indulged in illegal use of tobacco or alcohol and those individuals who can have indulged in first use of illicit drugs in order to assess if their behavior can be reversed through education. Required components include screening, referral, and follow-up. This strategy does not include any activity designed to determine if a person is in need of treatment.

(b) Screening. The screening process shall be designed to identify warning signs for alcohol, tobacco, and/or other drug abuse. The screening shall also identify STD/HIV risk factors as appropriate.

(c) Referral. The program shall maintain a current list of referral resources, including other services provided by the organization.

(d) Follow-up. The program shall conduct and document follow-up on referrals to ensure that the participant has presented for services.

(e) Documentation. The program shall maintain documentation of each screening which includes:

(1) date of the screening;

(2) zip code of the individual screened;

(3) demographics of the individual screened;

(4) referrals made; and

(5) any follow-up contacts.

§147.111.Community-Based Process.

(a) Each program that provides activities within this strategy shall work with other service providers, organizations, individuals, and families to effectively promote substance abuse services and improve the community's ability to prevent substance abuse and related problems.

(b) The program must establish formal linkages with other service providers to build a continuum of substance abuse services in the community. The program shall document active participation in collaborations to support community resource development.

(c) When the program coordinates services with another provider, there must be a written agreement that is renewed annually (by signature or other documented contact) and includes:

(1) names of the providers entering into the agreement;

(2) services or activities each provider will provide;

(3) signatures of authorized representatives; and

(4) dates of action and expiration.

(d) Documentation of community-based process activities shall include, as applicable:

(1) date, time, and duration of activity;

(2) key contact persons/providers involved;

(3) purpose and goal of activity;

(4) further action steps needed; and

(5) action or change achieved.

§147.112.Environmental and Social Policy.

(a) Each program that provides activities within this strategy shall take steps to influence the incidence and prevalence of substance abuse through:

(1) legal and regulatory strategies; or

(2) service and action-oriented activities.

(b) Activities must involve members of the community and other key stakeholders who will be impacted by the outcome.

(d) Documentation shall include, as applicable:

(1) date, time, and duration of activity;

(2) key contact persons/providers involved;

(3) purpose and goal of activity;

(4) further action steps needed; and

(5) action or change achieved.

(e) Documentation of minors and tobacco presentations shall document:

(1) content; and

(2) mode, time, and location of delivery.

(f) The program shall document the number of persons receiving written information/literature.

(g) For presentations, documentation shall include, as applicable:

(1) date, time, and duration of activity;

(2) location of activity;

(3) staff/volunteers conducting the activity;

(4) purpose and goal of activity; and

(5) number of participants.

§147.113.Intervention Services.

(a) Each program that provides activities within this strategy shall provide indicated prevention services to individual participants who are showing early warning signs of substance use or abuse and/or exhibiting other high risk problem behaviors. Family members may also be involved in these services.

(b) The program shall determine the needs of the participant (and family members) in a culturally appropriate, face-to-face screening. The screening shall gather information to identify the participant's risk and protective factors in five domains: individual, family, school, peer relationships, and community. Should the participant and/or family member need a more intensive level of services, the invention service provider facilitates their access to the needed service.

(1) Information about the individual shall include:

(A) age, gender, culture and ethnicity;

(B) individual assets;

(D) legal issues.

(2) Information about the family as permitted by law shall include:

(A) structure;

(B) functioning; and

(3) School information shall include:

(A) literacy level;

(B) academic performance; and

(4) Information about peer relationships shall include:

(A) ATOD use;

(B) gang or club involvement;

(D) social functioning.

(5) Information about the community shall include:

(A) economic status;

(B) general environment;

(D) availability of ATOD.

(c) The staff person and the participant (and family members, if appropriate) shall develop an intervention plan to address identified needs. The plan shall include:

(1) behavioral goals;

(2) timelines for completing the goals; and

(3) recommended indicated services.

(d) Intervention counseling sessions and screenings shall be conducted through confidential face-to-face contacts with participants and/or family members.

(e) The program may also provide crisis intervention services to participants and their families to intervene in situations which may or may not involve alcohol and drug use, and which may escalate if immediate attention is not provided.

(1) Crisis intervention may be offered through telephone contacts and/or face- to-face individual, family, and group interventions.

(2) Crisis intervention services must be documented.

(3) Crisis intervention services in the context of an indicated prevention program may be provided by non-licensed staff who are qualified to perform these functions.

(f) Intervention services for each participant shall be documented, including:

(1) the screening;

(2) the intervention plan;

(3) documentation of each intervention counseling session, including a summary of the intervention counseling session, and progress toward or away from identified goals;

(4) referrals and follow-ups; and

(5) an exit summary which includes a description of the results achieved and participant status at closure.

§147.114.Community Coalitions.

(a) Community coalitions shall implement strategies designed to accomplish the following goals:

(1) to prevent and reduce substance use and abuse among youth in each community served;

(2) to strengthen collaboration in communities and support the existing community-based prevention and treatment infrastructure; and

(3) to increase citizen participation and greater commitment among all sectors of the community toward reducing substance use and abuse. Community coalitions shall include (or document attempts to recruit) one or more representatives from each of these areas:

(F) community organizations serving youth;

(G) faith-based groups;

(H) civic and/or volunteer groups;

(I) health care professionals;

(J) State, local or tribal governmental agencies with expertise in substance abuse;

(K) other organizations involved in reducing substance abuse;

(L) law enforcement; and

(M) recovery community.

(b) Community coalitions shall implement community-based processes and environmental and social policy strategies in the community.

(c) Community coalitions, other than Statewide Incentive Grant (SIG) recipients, shall not provide or subcontract for the provision of individual direct services, including prevention education and skills training, alternative activities or problem identification and referral.

§147.115.Prevention Resource Centers.

(a) The goal of each prevention resource center shall be to increase the effectiveness and visibility of prevention of alcohol, tobacco and other drug use and abuse within the region it is funded to serve through information dissemination, community education, and identification of training resources and best practices in prevention.

(b) Each prevention resource center shall provide universal prevention strategies to the region it serves.

(c) Identified target groups shall include at a minimum: prevention professionals and volunteers; community leaders; teachers; school counselors and educational administrators; children and adolescents; parents and families; communities at large; local news media within the region served; and other persons in need of training in the area of alcohol, tobacco and other drugs.

(d) The following services are required of all funded prevention resource centers:

(1) prevention needs assessment and resource identification;

(2) prevention information marketing efforts;

(3) prevention training and referral to resources;

(4) prevention materials clearinghouse accessible to persons served in their region;

(5) regional coordination/networking; and

(6) regional prevention resource center web site and toll-free number.

(e) Each program shall submit reports as directed by the Commission.

§147.116.Pregnant and Parenting Adult and Adolescent Female Prevention Services.

In addition to the standards set forth in Chapter 148 of this title (relating to Standard of Care), prevention providers serving pregnant, post-partum female populations shall comply with the following standards of care:

(1) provide outreach and prevention services in prenatal clinics, hospitals, WIC offices, and other sites where adult and adolescent women may be seeking reproductive health care;

(2) utilize evidence based curricula for education on substance use, abuse and the effects of ATOD upon the fetus to women seeking services;

(3) identify pregnant women who are at high risk due to their use of ATOD or who are at high risk due to the use of ATOD by others and provide motivational counseling to reduce risk, provide education on reproductive health, fetal and child development, parenting, and family violence;

(4) provide referral of children and family members for substance prevention and/or treatment services;

(5) coordinate with other services and resources to include continuing care for pregnant, post-partum and parenting women;

(6) provide referral of infants and children 0-3 for early childhood intervention screening; and

(7) provide family service coordination for medical, perinatal, pediatric, WIC and other services that promote the health and well being of the individual.

(8) PPI programs shall comply with §147.112 (a), (b)(1) and (2), and (c) - (e) of this title (relating to Intervention Services).

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on January 23, 2004.

TRD-200400486

Thomas F. Best

General Counsel

Texas Commission on Alcohol and Drug Abuse

Effective date: September 1, 2004

Proposal publication date: August 29, 2003

For further information, please call: (512) 349-6668

Subchapter B. STANDARDS OF CARE FOR HIV PROGRAMMING

40 TAC §§147.201 - 147.204

The codes affected by the adoption of the new sections are Chapters 461 and 464 of the Health and Safety Code.

§147.201.Applicability.

The rules in this subchapter apply only to funded programs providing HIV services.

§147.202.HIV Required Services.

(a) Programs receiving TCADA HIV funds shall provide comprehensive HIV services to HIV infected persons with substance abuse problems and persons at risk of being infected as a result of substance abuse related activity and their families and/or significant others. HIV services shall include the following components:

(1) access to HIV antibody counseling and testing. Staff who perform HIV antibody counseling and testing must be currently registered as a Prevention Counseling and Partner Elicitation (PCPE) counselor with the Texas Department of Health.

(2) access to screening for TB and STDs.

(3) counseling to help change behaviors associated with risk of infection.

(b) Programs shall establish annual written service agreements with a comprehensive community resource network of related health, social service providers, and Texas Department of Health (TDH)-sponsored community or regional planning groups.

§147.203.Minimum Operational Requirements for HIV Outreach Programs.

(a) HIV outreach programs identify substance abusers who may or may not be seeking treatment and provide them with information, activities, referrals, and education directed toward informing drug users about the relationship between drug use (especially injecting drug activity) and communicable diseases. The target population is specific to:

(1) injecting drug users at risk of HIV infection;

(2) women, adolescents, and ethnic minority drug users at risk of infection from HIV and other communicable diseases through drug use or unprotected sexual activities; and

(3) other drug users at risk of HIV and other communicable diseases.

(b) HIV outreach service programs shall use outreach models that are scientifically sound. Unless the Commission approves another model in writing, programs shall use one or more of the following models:

(1) The Indigenous Leader Model: Intervention Manual, Wiebel, W. and Levin, L.B., February 1992;

(2) The National Institute on Drug Abuse (NIDA) Standard Intervention Model for Injection Drug Users: Intervention Manual, National AIDS Demonstration Research (NADR) program, National Institute on Drug Abuse, February 1992; and

(3) AIDS Intervention program for Injecting Drug Users: Intervention Manual, Rhodes, R., Humfleet, G.L., et al., February 1992.

(d) Commission-funded HIV outreach programs shall refer all persons found to be HIV-infected to Commission-funded HIV early intervention programs.

§147.204.Minimum Operational Requirements for HIV Early Intervention (HEI) Programs.

(a) Programs shall develop and implement strategies to identify HIV infected individuals by increasing awareness of HEI services within the target populations. Targets for such efforts should include HIV outreach programs, other HIV service organizations, substance abuse treatment programs, and related health organizations.

(b) Programs shall implement service coordination for HIV infected individuals, which accommodates needs associated with treatment for HIV and substance abuse services. Programs are linked as a network to all other HEI providers in the system.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on January 23, 2004.

TRD-200400487

Thomas F. Best

General Counsel

Texas Commission on Alcohol and Drug Abuse

Effective date: September 1, 2004

Proposal publication date: August 29, 2003

For further information, please call: (512) 349-6668

Subchapter C. NARCOTIC TREATMENT PROGRAMS PROVIDING PHARMACOTHERAPY SERVICES

40 TAC §§147.301 - 147.304

The codes affected by the adoption of the new sections are Chapters 461 and 464 of the Health and Safety Code.

§147.301.Applicability.

The rules in this subchapter apply only to funded Narcotic Treatment programs providing pharmacotherapy services.

§147.302.Program Objectives.

The ultimate objective for funding pharmacotherapy services is that this addicted population can have active lives, hold responsible jobs, succeed in school, care for families and have no greater incidence of psychopathology or general medical problems that their drug-free peers. Pharmacotherapy services are provided to substance abusing/dependent persons who are addicted to opioids/narcotics. Services include methadone administration and LAAM administration or other drugs that might be approved by the Federal Drug Administration (FDA) for therapy and approved by the Commission for payment. Narcotic treatment programs providing pharmacotherapy services should work to foster de-stigmatization, encourage the development of new clinical strategies and treatment strategies, promote individualized treatment planning, and ensure client rights.

§147.303.Required Services.

(a) Service components, modalities and delivery systems.

(1) Programs shall provide to staff and clients basic substance abuse/HIV/STDs/TB information. The information should include routes of transmission, methods of prevention, high-risk behaviors, occupational precautions, and behaviors in violation of Texas laws.

(2) Methadone/LAAM dosage levels should be conducted by a trained physician based on data that is adequate for each individual client.

(3) Programs shall provide or offer through a memorandum of understanding (MOU) with an appropriate service provider, high-risk prenatal care, proper dietary/nutrition requirements, ongoing individual, family, or group counseling, and parenting classes in conjunction with methadone treatment.

(4) Programs must ensure that methadone/LAAM clients have access to inpatient, residential or outpatient treatment for medical, surgical, psychiatric, and non-opiate chemical dependency conditions without interruption of pharmacotherapy services.

(b) Program design and implementation must address client's access to a full continuum of care to include substance free treatment for ATOD.

(c) Identify those services and/or collaborative arrangements that address co-occurring psychiatric and substance abuse disorders requirements.

(d) Treatment plans must address, if applicable:

(1) client's abuse or dependence on other substances; and

(2) employment counseling and support.

§147.304.Minimum Operational Requirements.

(a) All narcotic treatment programs providing pharmacotherapy services shall maintain certification and licensure compliance with applicable statutes and regulations adopted by: Texas Department of Health; Center for Substance Abuse Treatment; and the Drug Enforcement Agency.

(b) Narcotic treatment programs providing pharmacotherapy shall ensure that clients served in programs funded by the Commission receive face to face individual chemical dependency counseling sessions, a minimum of once per week, during the initial 45 days of treatment. After the initial 45 days of continuous treatment, the client shall receive at least one face to face individualized counseling session every two weeks. After one year of continuous treatment, the client shall receive at least one individual counseling session each month.

(c) For all methadone clients, including those admitted on or after September 1, 2002, the maximum duration of methadone services under a contract shall be 18 months. The executive director of the Commission may grant exceptions to this restriction upon application by the contractor. Any request for exception must be justified by documentation showing that the client needs additional methadone services. The executive director may consider whether the client has a documented medical, physical or mental health condition, which would prevent gainful and sustainable employment. If the need for continued services is due to a medical or physical condition, the assessment to justify extended services must be performed by a licensed health professional as defined by §141.101(71) of this title (relating to Definitions). If it is a result of a mental health condition, the assessment must be conducted by a qualified mental health professional as defined by §141.101(99) of this title. The assessment of the client's condition must be in direct consultation with a physician licensed by, and in good standing with, the Texas State Board of Medical Examiners.

(d) All narcotic treatment programs providing pharmacotherapy shall adopt policies and procedures that conform with §144.418(b) of this title (relating to Capacity Reporting) and §147.701 of this title (relating to Waiting Lists and Interim Services).

(e) All narcotic treatment programs providing pharmacotherapy shall complete a client fee assessment on each Commission-funded client every six months.

(f) All direct care employees shall receive annual training that includes: symptoms of opiate withdrawal; drug urine screens; current standards of pharmacotherapy; and poly-drug addiction.

(g) The narcotic treatment program providing pharmacotherapy shall ensure that each individual who requests and is in need of treatment for intravenous drug abuse is admitted to an appropriate program not later than 21 days after making the request. Interim services must be provided within 48 hours.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on January 23, 2004.

TRD-200400488

Thomas F. Best

General Counsel

Texas Commission on Alcohol and Drug Abuse

Effective date: September 1, 2004

Proposal publication date: August 29, 2003

For further information, please call: (512) 349-6668

Subchapter D. OUTREACH, SCREENING, ASSESSMENT AND REFERRAL (OSAR) SERVICES

40 TAC §147.401, §147.402

The codes affected by the adoption of the new sections are Chapters 461 and 464 of the Health and Safety Code.

§147.401.Applicability.

The rules in this subchapter apply only to funded outreach, screening, assessment and referral (OSAR) services.

§147.402.Standards for Outreach, Screening, Assessment and Referral Service Provision.

(a) OSARs shall provide screening and assessment, brief interventions, and referral services to individuals with potential substance use disorders.

(b) Screening shall include determination of financial and clinical eligibility for Commission-funded services.

(c) Services shall be offered at times and in locations that facilitate access for target populations, including off-site locations.

(d) Screening and emergency response shall be available 24 hours a day, seven days a week. Screening and assessment shall be conducted by qualified staff using the Commission's Behavioral Health Integrated Provider System (BHIPS).

(e) Screening and assessment shall be sufficient to determine the problem severity, service needs, and stage of change. All clients referred for treatment shall have a DSM diagnosis.

(f) Services shall be provided by qualified staff with skills in motivational interviewing and other engagement techniques.

(g) If an individual is eligible and motivated for Commission-funded services, the OSAR shall arrange for admission to the appropriate service based on client needs and preferences.

(h) The OSAR shall provide brief interventions to help individuals move through the stages of change to a state of readiness to address substance use problems. Brief intervention may be provided as pre-treatment or interim services or as an independent service.

(i) Individuals who are not eligible for TCADA-funded services shall be referred to service providers consistent with their needs and financial resources.

(j) Screening and assessment shall, when appropriate, address the family as a unit and referrals shall be provided for family members, including prevention services for children.

(k) The program shall maintain a resource directory on file that contains current information about local referral resources, including location and contact information, services offered, and eligibility criteria.

(l) OSARs shall coordinate client care across the continuum of care.

(1) A care plan shall be developed for individuals entering Commission-funded services.

(2) The OSAR shall facilitate timely placement into an appropriate level of service.

(3) The OSAR shall provide long-term service coordination for high-severity clients, including:

(A) participating in evaluating treatment;

(B) facilitating intensity of services as determined by client needs and progress;

(D) conducting post-discharge follow-up;

(E) providing long-term monitoring; and

(F) offering brief interventions when needed to maintain stability.

(m) OSARs shall coordinate with Commission-funded providers to ensure a seamless episode of care and maximize use of available resources.

(n) OSARs shall promote community awareness of available services through outreach with emphasis on increasing access for priority populations.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on January 23, 2004.

TRD-200400489

Thomas F. Best

General Counsel

Texas Commission on Alcohol and Drug Abuse

Effective date: September 1, 2004

Proposal publication date: August 29, 2003

For further information, please call: (512) 349-6668

Subchapter E. TREATMENT PERFORMANCE STANDARDS

40 TAC §147.501, §147.502

The codes affected by the adoption of the new sections are Chapters 461 and 464 of the Health and Safety Code.

§147.501.Applicability.

The rules in this subchapter apply only to funded treatment programs.

§147.502.Select Performance Measure Definitions.

(a) Minimum Duration of Retention in Treatment Reporting Requirement. This reporting requirement applies to intensive residential, supportive residential and outpatient programs except for pharmacotherapy programs. For a client to have completed the minimum threshold of retention in treatment, the client record must document the client-specific information that supports the reason for discharge listed on the discharge report in BHIPS. A client will be considered to have completed the minimum duration of retention in treatment if:

(1) In intensive or supportive residential program, the client's length of stay is at least 14 days.

(2) In outpatient programs, the client has attended at least 14 individual or group sessions.

(3) The discharge summary or transfer note shall indicate whether the client has successfully completed the minimum duration of retention in treatment according to the above criteria (unless the reasons for earlier discharge are clinically appropriate and documented) and must be signed by a qualified credentialed counselor (QCC).

(b) Abstinence. This measure applies to all programs except for pharmacotherapy programs and detoxification programs. Abstinence is the percent of clients who report no use of alcohol or drugs in the past 30 days when contacted 60 days after discharge from the treatment program.

(c) Referral Rate. This measure applies to detoxification programs. Referral rate is the percentage of clients who have completed detoxification treatment and are transferred continuing substance abuse treatment as defined below.

(d) Completion of Detoxification Treatment. The client record must record that both the following criteria have been met. Levels of toxic substances and withdrawal symptoms have been sufficiently reduced so that the client is medically stable and able to participate in a less intensive level of treatment. A statement to this effect must be signed by the medical director or designee of the program in the discharge summary or transfer note. A discharge plan or discharge note must be completed prior to discharge or transfer in accordance with §148.805 of this title (relating to Discharge).

(e) Referral. For a client to have been transferred from detoxification to continuing substance abuse treatment, the client records must indicate that one of the following criteria has been met.

(1) The client has been discharged from the program and referred to a less intensive level of treatment in another facility, and the program has conducted follow-up to determine the results of the referral. The referral and follow-up must be documented in the client record.

(2) The client has been transferred to a less intensive level of treatment within the organization. The client record must include a transfer note to document the transfer.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on January 23, 2004.

TRD-200400490

Thomas F. Best

General Counsel

Texas Commission on Alcohol and Drug Abuse

Effective date: September 1, 2004

Proposal publication date: August 29, 2003

For further information, please call: (512) 349-6668

Subchapter F. TREATMENT FOR PREGNANT AND POST PARTUM WOMEN WITH DEPENDENT CHILDREN

40 TAC §§147.601 - 147.604

The codes affected by the adoption of the new sections are Chapters 461 and 464 of the Health and Safety Code.

§147.601.Applicability.

The rules in this subchapter apply only to funded treatment programs for pregnant and post partum women with dependent children.

§147.602.Purpose of Program.

The Commission shall provide awards or contracts for the purpose of providing to pregnant and postpartum women and their children, including children in the custody of the court or the State, treatment for substance abuse through programs in which, during the course of receiving treatment:

(1) the women reside in facilities provided by the programs;

(2) the minor children of the women reside with the women in such facilities, if the women so request; and

(3) the services described in this section are available to or on behalf of the women.

§147.603.Availability of Services.

(a) A program will ensure:

(1) treatment services and each supplemental service will be available through the program, either directly or through agreements with other entities; and

(2) the services will be made available to each woman admitted to the program.

(b) A provider shall provide or arrange for transportation to all services required and not provided at the facility.

§147.604.Individualized Plan of Services.

A funding agreement for an award for provision of services under this subchapter shall contain the following requirements:

(1) In providing authorized services for an eligible woman, the program shall, in consultation with the women, prepare an individualized plan for the provision to the woman of the services.

(2) Treatment services under the plan will include:

(A) individual, group, and family counseling, as appropriate, regarding substance abuse; and

(B) follow-up services to assist the woman in preventing a relapse into such abuse.

(3) Treatment services provided shall be gender specific.

(4) Required supplemental services for eligible women shall include:

(A) provision of, or referral to, prenatal and postpartum health care;

(B) referrals for necessary hospital services; and

(5) Required supplemental services for the infants and children of the woman shall be directly provided or provided by referral if the provider does not employ qualified staff:

(A) pediatric health care, including treatment for any perinatal effects of maternal substance abuse and including screenings regarding the physical and mental development of the infants and children and immunizations;

(B) provision of, or referral to, counseling and other mental health services, in the case of children; and

(6) Therapeutic interventions for children in custody of women in treatment shall address their development needs and issues of sexual abuse and neglect either directly or through referral.

(7) Supervision of children shall be provided during periods in which the woman is engaged in therapy or in other necessary health or rehabilitative activities.

(8) Training in parenting shall be provided.

(9) Counseling on HIV and on acquired immune deficiency syndrome (AIDS), STDs and TB shall be provided directly or by referral.

(A) Clients shall be given the opportunity for pre- and post-test counseling on HIV and AIDS.

(B) Clients with a positive test for HIV shall be referred, when possible, to a Commission HEI/HIV coordinator or other community resources to be considered for services.

(D) Clients shall be offered testing for sexually transmitted disease.

(10) Counseling on domestic violence and sexual abuse shall be provided, directly or by referral.

(11) Counseling on obtaining employment, including the importance of graduating from a secondary school or GED course, shall be provided.

(12) Reasonable efforts shall be made to preserve and support the family units of the women, including promoting the appropriate involvement of parents and others, and counseling the children of the women.

(A) In cases when the State has custody of the minor child, all efforts will be made to participate in a family reunification plan with the custodial agency.

(B) The provider will work with the court and the client to meet the conditions of the court to reunite the family.

(13) Planning for and counseling to assist reentry into society shall be provided, both before and after discharge, including referrals to any public or nonprofit private entities in the community involved that provide services appropriate for the women and the children of the women.

(14) Service coordination shall be provided, to include:

(A) assessing the extent to which authorized services are appropriate for the women and their children;

(B) in the case of the services that are appropriate, ensuring that the services are provided in a coordinated manner; and

(C) assistance in establishing eligibility for assistance under Federal, State, and local programs providing health services, mental health services, housing services, employment services, educational services, or social services.

(15) The program shall provide outreach services in the communities served to help identify women who are engaging in substance abuse and to encourage the women to seek services.

(16) A program providing services will:

(A) be operated at a location that is accessible to low-income pregnant and postpartum women; and

(B) provide authorized services in the language and the cultural context that is most appropriate.

(17) A funded program shall provide for continuing education in treatment services for the individuals who will provide treatment in the program to be operated by the program pursuant to such subsection.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on January 23, 2004.

TRD-200400491

Thomas F. Best

General Counsel

Texas Commission on Alcohol and Drug Abuse

Effective date: September 1, 2004

Proposal publication date: August 29, 2003

For further information, please call: (512) 349-6668

Subchapter G. CAPACITY MANAGEMENT AND INTERIM SERVICES

40 TAC §147.701

The new section is adopted pursuant to the Texas Health and Safety Code §461.012(a)(15) which provides the Commission with the authority to adopt rules governing its functions, including rules that prescribe the policies and procedures it follows in administering any Commission program and §461.0141 which provides the Commission with authority to adopt rules regarding purchase of services. The new section is also adopted under Texas Health and Safety Code §464.009, which provides TCADA with the authority to adopt rules and standards for the licensure of chemical dependency treatment facilities.

The codes affected by the adoption of the new section are Chapters 461 and 464 of the Health and Safety Code.

§147.701.Waiting List and Interim Services.

The following provisions apply to all funded treatment services:

(1) The program shall maintain a waiting list or other organized and documented system to track eligible individuals who have been screened but cannot be treated immediately because of insufficient capacity. Eligible individuals who cannot enter treatment due to other circumstances may be placed on the waiting list, but the provider shall not hold empty beds or slots for anticipated clients for more than 48 hours.

(2) The program shall establish criteria that place members of the priority populations at the top of the waiting list.

(3) When individuals are placed on a waiting list, they shall also be referred to an entity that can provide testing, counseling, and treatment for HIV, TB and STDs.

(4) The program shall consult the State's facility capacity management system to facilitate prompt placement in an appropriate treatment program within a reasonable geographic area.

(5) The program shall implement written procedures to maintain contact with individuals waiting for admission.

(6) When a program does not have capacity to admit an injecting drug user or pregnant female, the program shall place the individual in another treatment facility or provide reasonable access to interim services (when another treatment facility is not available).

(A) Interim services shall be offered within 48 hours.

(B) Interim services shall include counseling and education about HIV and TB, including the risks of needle-sharing, the risks of transmission to sexual partners and infants, and steps that can be taken to prevent transmission. Referrals for HIV or tuberculosis treatment shall be provided if necessary. For pregnant females, interim services shall also include counseling about the effects of alcohol and drug use on the fetus and referrals for prenatal care.

(7) The program shall ensure that each individual who requests and is in need of treatment for intravenous drug abuse is admitted to an appropriate program not later than 21 days after making the request. Interim services must be provided within 48 hours as described in paragraph (6)(A) of this section.

(8) Capacity management may be handled through a centralized intake system.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on January 23, 2004.

TRD-200400492

Thomas F. Best

General Counsel

Texas Commission on Alcohol and Drug Abuse

Effective date: September 1, 2004

Proposal publication date: August 29, 2003

For further information, please call: (512) 349-6668

Part 12. TEXAS BOARD OF OCCUPATIONAL THERAPY EXAMINERS

Chapter 364. REQUIREMENTS FOR LICENSURE

40 TAC §364.4

The Texas Board of Occupational Therapy Examiners adopts amendments to §364.4, concerning Licensure by Endorsement, with changes to the proposed text as published in the July 25 2003, issue of Texas Register (28 TexTeg 5842).

The section was amended to require applicants to submit the correct documents for their application.

One letter was received regarding adoption of the amendment. from the American Occupational Therapy Association that no score information exists for those who were certified prior to 1985.

The amendment is proposed under the Occupational Therapy Practice Act, Title 3, Subchapter H, Chapter 456, Occupations Code, which provides the Texas Board of Occupational Therapy Examiners with the authority to adopt rules consistent with this Act to carry out its duties in administering this Act.

Title 3, Subchapter H, Chapter 454 of the Occupations Code is affected by this amended section.

§364.4.Licensure by Endorsement.

(a) The board may issue a license by endorsement to applicants currently licensed in another state, District of Columbia or territory of the United States which has licensing requirements substantially equivalent to this state. Previous Texas licensees are not eligible for License by Endorsement. An Applicant seeking endorsement must:

(1) meet all provisions for §364.1 of this title (relating to Requirements for License);

(2) arrange to have NBCOT's score report form sent directly to the board except applicants examined prior to 1985 should have NBCOT provide the board it's Verification of Certification form.

(3) Submit verification of license in good standing from the state(s) in which the applicant is currently licensed. This must be an original verification sent directly by the licensing board in that state, or,

(4) submit, if applying from a non-licensing state or US military and not holding a current state license , a Verification of Employment form substantiating occupational therapy employment for at least 2 years immediately preceding application for a Texas license

(b) Provisional License:

(1) The Board may grant a Provisional License to an applicant who is applying for License by endorsement if there is an unwarranted delay in the submission of required documentation outside the applicant's control. All other requirements for licensure by endorsement must be met. The applicant must also submit the Provisional License fee as set by the Executive Council. The Board may not grant a provisional license to an applicant with disciplinary action in their license history, or to an applicant with pending disciplinary action. The Provisional License will have a duration of 180 days.

(2) The Board may grant a Provisional License to an applicant who has previously held a Texas license and does not meet the requirements for restoration of a license as outlined in Chapter 370 provided that such applicant has a current license in good standing in another state which has licensing requirements substantially equivalent to Texas. Upon receiving a passing score from NBCOT, a new regular license will be issued, as outlined in §364.2 of this chapter. A failing score will result in revocation of the Provisional License. The Provisional License will have a duration of 180 days. The applicant must:

(A) submit a new application as outlined in §364.1 and §364.2 of this title;

(B) submit verification of the current license in another state or US territory;

(D) submit a copy of the confirmation of registration for NBCOT's national examination.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on January 23, 2004.

TRD-200400482

John Maline

Executive Director

Texas Board of Occupational Therapy Examiners

Effective date: February 12, 2004

Proposal publication date: July 25, 2003

For further information, please call: (512) 305-6962